psych – substance abuse

7/30/2019 Psych – Substance Abuse

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Psych – Substance Abuse

1) The nurse is planning activities for a client who has bipolar disorder with aggressive socialbehavior. Which of the following activities would be most appropriate for this client?

1. Ping pong

2. Writing3. Chess4. Basketball

2) A client is admitted to the hospital with a diagnosis of major depression, severe, singleepisode. The nurse assesses the client and identifies a nursing diagnosis of imbalanced nutritionrelated to poor nutritional intake. The most appropriate nursing intervention related to thisdiagnosis is:

1. Explain to the client the importance of a good nutritional intake2. Weight the client 3 times per week before breakfast

3. Report the nutritional concern to the psychiatrist and obtain a nutritional consultation assoon as possible.4. Consult with the nutritionist, offer the client several small meals per day, and schedule brief

nursing interactions with the client during these times.

3) In planning activities for the depressed client, especially during the early stages of hospitalization, which of the following plans is best?

1. Provide an activity that is quiet and solitary to avoid increased fatigue, such as working on apuzzle or reading a book.

2. Plan nothing until the client asks to participate in milieu.

3. Offer the client a menu of daily activities and insist the client participate in all of them4. Provide a structured daily program of activities and encourage the client to participate.

4) The depressed client verbalizes feelings of low self-esteem and self-worth typified bystatements such as “I’m such a failure… I can’t do anything right!” The best nursing responsewould be:

1. To tell the client this is not true; that we all have a purpose in life.2. To remain with the client and sit in silence; this will encourage the client to verbalize feelings3. To reassure the client that you know how the client is feeling and that things will get better 4. To identify recent behaviors or accomplishments that demonstrates skill ability.

5) A client with a diagnosis of major depression, recurrent with psychotic features is admitted tothe mental health unit. To create a safe environment for the client, the nurse most importantlydevises a plan of care that deals specifically with the client’s:

1. Disturbed thought processes2. Imbalanced nutrition3. Self-care deficit4. Deficient knowledge



6) A depressed client is ready for discharge. The nurse feels comfortable that the client has agood understanding of the disease process when the client states:

1. “I’ll never let this happen to me again. I won’t let my boss or my job or my family get to me!”2. “It’s important for me to eat well, exercise, and to take my medication. If I begin to lose my

appetite or not sleep well, I’ve got to get in to see my doctor.”3. “I’ve learned that I’m a good person and that I am worthy of giving and receiving love. I don’t

need anyone; I have myself to rely on!”4. “I don’t know what happened to me. I’ve always been able to make decisions for myself andfor my business. I don’t ever want to feel so weak or vulnerable again!”

7) The nurse assesses a client with the admitting diagnosis of bipolar affective disorder, mania.The symptom presented by the client that requires the nurse’s immediate intervention is theclient’s:

1. Outlandish behaviors and inappropriate dress2. Grandiose delusions of being a royal descendent of King Arthur.3. Nonstop physical activity and poor nutritional intake

4. Constant, incessant talking that includes sexual innuendoes and teasing the staff

8) The nurse reviews the activity schedule for the day and plans which activity for the manicclient?

1. Brown-bag luncheon and book review2. Tetherball3. Paint-by-number activity4. Deep breathing and progressive relaxation group

9) A hospitalized client is being considered for ECT. The client appears calm, but the family is

anxious. The client’s mother begins to cry and states “My son’s brain will be destroyed. How canthe doctor do this to him?” The nurses best response is:

1. “It sounds as though you need to speak with the psychiatrist”2. “Your son has decided to have this treatment. You should be supportive to him.”3. “Perhaps you’d like to see the ECT room and speak to the staff.”4. “It sounds as though you have some concerns about the ECT procedure. Why don’t we sit

down together and discuss any concerns you may have.”

10) The manic client announces to everyone in the dayroom that a stripper is coming to performthis evening. When the nurse firmly states that this will not happen, the manic client becomesverbally abusive and threatens physical violence to the nurse. Based on the analysis of thissituation, the nurse determines that the most appropriate action would be to:

1. With assistance, escort the manic client to her room and administer Haldol as prescribed if needed

2. Tell the client that smoking privileges are revoked for 24 hours3. Orient the client to time, person, and place4. Tell the client that the behavior is not appropriate.



11) Select all nursing interventions for a hospitalized client with mania who is exhibitingmanipulative behavior.

1. Communicate expected behaviors to the client2. Enforce rules and inform the client the he or she will not be allowed to attend group therapy

sessions.3. Ensure that the client knows that he or she is not in charge of the nursing unit

4. Be clear with the client regarding the consequences of exceeding limits set regardingbehavior.5. Assist the client in testing out alternative behaviors for obtaining needs

12) A woman comes into the ER in a severe state of anxiety following a car accident. The mostappropriate nursing intervention is to:

1. Remain with the client2. Put the client in a quiet room3. Teach the client deep breathing4. Encourage the client to talk about their feelings and concern.

13) When planning the discharge of a client with chronic anxiety, the nurse directs the goals atpromoting a safe environment at home. The most appropriate maintenance goal should focus onwhich of the following?

1. Continued contact with a crisis counselor 2. Identifying anxiety-producing situations3. Ignoring feelings of anxiety4. Eliminating all anxiety from daily situations

14) The nurse is monitoring a client who abuses alcohol for signs of alcohol withdrawal. Which of

the following would alert the nurse to the potential for delirium tremors?

1. Hypertension, changes in LOC, hallucinations2. Hypotension, ataxia, hunger 3. Stupor, agitation, muscular rigidity4. Hypotension, coarse hand tremors, agitation

15) The spouse of a client admitted to the mental health unit for alcohol withdrawal says to thenurse “I should get out of this bad situation.” The most helpful response by the nurse would be:

1. “I agree with you. You should get out of this situation.”2. “What do you find difficult about this situation?”3. “Why don’t you tell your husband about this?”4. “This is not the best time to make that decision.”

16) The nurse determines that the wife of an alcoholic client is benefiting from attending Al-Anongroup when she hears the wife say:

1. “My attendance at the meetings has helped me to see that I provoke my husband’sviolence.”

2. “I no longer feel that I deserve the beatings my husband inflicts on me.”



3. “I can tolerate my husband’s destructive behavior now that I know they are common withalcoholics.”

4. “I enjoy attending the meetings because they get me out of the house and away from myhusband.”

17) The client has been hospitalized and is participating in a substance abuse therapy groupsessions. On discharge, the client has consented to participate in AA community groups. The

nurse is monitoring the client’s response to the substance abuse sessions. Which statement by theclient best indicates that the client has developed effective coping response styles and hasprocessed information effectively for self use?

1. “I know I’m ready to be discharged. I feel I can say ‘no’ and leave a group of friends if theyare drinking… ‘No Problem.’”

2. “This group has really helped a lot. I know it will be different when I go home. But I’m surethat my family and friends will all help me like the people in this group have… They’ll all helpme… I know they will… They won’t let me go back to my old ways.”

3. “I’m looking forward to leaving here. I know that I will miss all of you. So, I’m happy and I’msad, I’m excited and I’m scared. I know that I have to work hard to be strong and that

everyone isn’t going to be as helpful as you people.”4. “I’ll keep all my appointments; go to all my AA groups; I’ll do everything I’m supposed to…Nothing will go wrong that way.”

18) A hospitalized client with a history of alcohol abuse tells the nurse, “I am leaving now. I haveto go. I don’t want anymore treatment. I have things that I have to do right away.” The client hasnot been discharged. In fact, the client is scheduled for an important diagnostic test to beperformed in 1 hour. After the nurse discusses the client’s concerns with the client, the clientdresses and begins to walk out of the hospital room. The most important nursing action is to:

1. Restrain the client until the physician can be reached2. Call security to block all areas3. Tell the client that the client cannot return to this hospital again if the client leaves now.4. Call the nursing supervisor.

19) Select the appropriate interventions for caring for the client in alcohol withdrawal.

1. Monitor vital signs2. Provide stimulation in the environment3. Maintain NPO status4. Provide reality orientation as appropriate5. Address hallucinations therapeutically

20) Which of the following nursing actions would be included in a care plan for a client with PTSDwho states the experience was “bad luck”?

1. Encourage the client to verbalize the experience2. Assist the client in defining the experience3. Work with the client to take steps to move on with his life4. Help the client accept positive and negative feelings

21) Which of the following psychological symptoms would the nurse expect to find in ahospitalized client who is the only survivor of a train accident?



1. Denial2. Indifference3. Perfectionism4. Trust

22) Which of the following communication guidelines should the nurse use when talking with aclient experiencing mania?

1. Address the client in a light and joking manner 2. Focus and redirect the conversation as necessary3. Allow the client to talk about several different topic4. Ask only open ended questions to facilitate conversations

23) What information is important to include in the nutritional counseling of a family with a member who has bipolar disorder?

1. If sufficient roughage isn’t eaten while taking lithium, bowel problems will occur.2. If the intake of carbohydrates increases, the lithium level increases.

3. If the intake of calories is reduced, the lithium level will increase4. If the intake of sodium increases, the lithium level will decrease.

24) In conferring with the treatment team, the nurse should make which of the followingrecommendations for a client who tells the nurse that everyday thoughts of suicide are present?

1. A no-suicide contract2. Weekly outpatient therapy3. A second psychiatric opinion4. Intensive inpatient treatment

25) Which of the following short term goals is most appropriate for a client with bipolar disorder who is having difficulty sleeping?

1. Obtain medication for sleep2. Work on solving a problem3. Exercise before bedtime4. Develop a sleep ritual

ANSWERS

1. B. Solitary activities that require a short attention span with mild physical exertion are themost appropriate activities for a client who is exhibiting aggressive behavior. Writing, walkswith staff, and finger painting are activities that minimize stimuli and provide a constructiverelease for tension. Competitive games can stimulate aggression and increase psychomotor activity.

2. D. Change in appetite is one of the major symptoms of depression. Reporting to thepsychiatrist and nutritionist is to some degree correct but lacks the method as to how onewould increase food intake.

3. D. A depressed person experiences a depressed mood and is often withdrawn. The personalso experiences difficulty concentrating, loss of interest or pleasure, low energy, fatigue,and feelings of worthlessness and poor self-esteem. The plan of care needs to provide



successful experiences in a stimulating yet structured environment. Option 3 is a forcefuland absolute approach.

4. D. Feelings of low self-esteem and worthlessness are common symptoms of the depressedclient. An effective plan of care to enhance the client’s personal self-esteem is to provideexperiences for the client that are challenging but will not be met with failure. Reminders of the client’s past accomplishments or personal successes are ways to interrupt the client’snegative self talk and distorted cognitive view of self. Silence may be interpreted as

agreement. Options 1 and 3 give advice and devalue the client’s feelings.5. A. major depression, recurrent, with psychotic features alerts the nurse that in addition tothe criteria that designate the diagnosis of major depression, one also must deal with theclient’s psychosis. Psychosis is defined as a state in which a person’s mental capacity torecognize reality and to communicate and relate to others is impaired, thus interfering withthe person’s capacity to deal with the demands of life. Altered thought processes generallyindicate a state of increased anxiety in which hallucinations and delusions prevail. Althoughall of the nursing diagnoses may be appropriate because the client is experiencingpsychosis, option 1 is correct.

6. B. The exact cause of depression is not known but is believed to be related to biochemicaldisruption of neurotransmitters in the brain. Diet, exercise, and medication are recognizedtreatment for the disease process.

7. C. Mania is a mood characterized by excitement, euphoria, hyperactivity, excessive energy,decreased need for sleep, and impaired ability to concentrate or complete a single train of thought. Mania is a period when the mood is predominately elevated, expansive, or irritable.

All options reflect a client’s possible symptomatology. Option 3, however, clearly presents aproblem that compromises one’s physiological integrity and needs to be addressedimmediately.

8. B. A person who is experiencing mania is overactive and full of energy, lacks concentration,and has poor impulse control. The client needs an activity that will allow use of excessenergy yet not endanger others during the process. Options 1, 3, and 4 are relatively sedateactivities that require concentration, a quality that is lacking in the manic state. Suchactivities lead to increased frustration and anxiety for the client. Tetherball is an exercisethat uses the large muscle groups of the body and is a great way to expend the increasedenergy that the client is experiencing.

9. D. The nurse encourages the client and the family to verbalize fears and concerns. Theother options avoid dealing with concerns and are blocks to communication.

10. A. The client is at risk for injury to self and others and therefore should be escorted out of thedayroom. Antipsychotic medications are useful to manage the manic client. Hyperactive andagitated behavior usually responds to Haldol. Option 2 may increase the agitation that alreadyexists in this client. Orientation will not halt the behavior. Telling the client that the behavior is notappropriate already has been attempted by the nurse.

11. A, D, and E. Interventions for dealing with the client exhibiting manipulative behavior includesetting clear, consistent, and enforceable limits on manipulative behaviors; being clear with theclient regarding the consequences of exceeding limits set; following through with theconsequences in a non-punishment manner; and assisting the client in identifying strengths and intesting out alternative behaviors for obtaining needs. Enforcing rules and informing the client thathe or she will not be allowed to attend group therapy sessions is a violation of the client’s rights.Ensuring the client knows that he or she is not in charge of the nursing unit is inappropriate, power struggles need to be avoided.



12. A. If a client with severe anxiety is left alone; the client may feel abandoned and becomeoverwhelmed. Placing the client in a quiet room is also important, but the nurse must stay with theclient. Teaching the client deep breathing or relaxation is not possible until the anxiety decreases.Encouraging the client to discuss concerns and feelings would not take place until the anxiety hasdecreased.

13. B. Recognizing situations that produce anxiety allows the client to prepare to cope with anxiety

or avoid a specific stimulus. Counselors will not be available for all anxiety-producing situations,and this option does not encourage the development of internal strengths. Ignoring feelings will notresolve anxiety. Elimination anxiety from life is impossible.

14. A. Some of the symptoms associated with delirium tremors typically are anxiety, insomnia,anorexia, hypertension, disorientation, hallucinations, and changes in LOC, agitation, fever, anddelusions.

15. B. The most helpful response is one that encourages the client to problem solve. Givingadvice implies that the nurse knows what is best and can foster dependency. The nurse should notagree with the client, nor should the nurse request that the client provide explanations.

16. B. Al-Anon support groups are protected, supportive opportunity for spouses and significantothers to learn what to expect and to obtain excellent pointers about successful behavior changes.Option 2 is the most healthy response because is exemplifies and understanding that the alcoholicpartner is responsible for his behavior and cannot be allowed to blame family members for loss of control.

17. C. In the defense mechanism of denial the person denies reality. Option 1 identifies denial. Inoption 2 the client is relying heavily on others, and the client’s focus of control is external. In option4 the client is concrete and procedure oriented; again the client identifies that “Nothing will gowrong that way” if the client follows all the directions. In option 3 the client is expressing realconcern and ambivalence about discharge from the hospital. The client also demonstrates realityin that statement.

18. D. A nurse can be charged with false imprisonment if a client is made to believe wrongfullythat the client cannot leave the hospital. Most health care facilities have documents that the clientis asked to sign that relate to the client’s responsibilities when the client leaves against medicaladvice. The client should be asked to sign this document before leaving. The nurse should requestthat the client wait to speak to the physician before leaving, but if the client refuses to do so, thenurse cannot hold him against his will. Restraining the client and calling security to block exitsconstitutes false imprisonment. Any client has a right to health care and cannot be told otherwise.

19. A, D, and E. When the client is experiencing withdrawal of alcohol, the priority of care is toprevent the client from harming himself or others. The nurse would provide a low stimulatingenvironment to maintain the client in as calm a state as possible. The nurse would monitor vitalsigns closely and report abnormal findings. The nurse would reorient the client to reality frequentlyand would address hallucinations therapeutically. Adequate nutritional and fluid intake needs to bemaintained.

20. B. The client must define the experience as traumatic to realize the situation wasn’t under hispersonal control. Encouraging the client to verbalize the experience without first addressing thedenial isn’t a useful strategy. The client can move on with life only after acknowledging the trauma



and processing the experience. Acknowledgement of the actual trauma and verbalization of theevent should come before the acceptance of feelings.

21. A. Denial can act as a protective response. The client tends to be overwhelmed anddisorganized by the trauma, not indifferent to it. Perfectionism is more commonly seen in clientswith eating disorders, not in clients with PTSD. Clients who have had a severe trauma oftenexperience an inability to trust others.

22. B. To decrease stimulation, the nurse should attempt to redirect and focus the client’scommunication, not allow the client to talk about different topics. By addressing the client in a lightand joking manner, the conversation may contribute to the client’s feeling out of control. For amanic client, it’s best to ask closed questions because open-minded questions may enable theclient to talk endlessly, again possibly contributing to the client’s feeling out of control.

23. D. Any time the level of sodium increases, such as with a change in the dietary intake, thelevels of lithium will decrease.

24. D. For a client thinking about suicide on a daily basis, inpatient care would be the best

intervention. Although a no-suicide contract is an important strategy, this client needs additionalcare. The client needs a more intensive level of care than weekly outpatient therapy. Immediateintervention is paramount, not a second psychiatric opinion.

25. D. A sleep ritual or nighttime routine helps the client to relax and prepare for sleep. Obtainingsleep medication is a temporary solution. Working on problem solving may excite the client rather than tire him. Exercise before retiring is inappropriate.

psych – substance abuse

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